CRC OBES EVAL TRTMNT ESSNTLS PDF

Preface

It is clear that obesity is one of our nation's biggest health care challenges. It is associated with our most common causes of mortality and morbidity as well as with producing considerable psychosocial discomfort. The incidence of this killer disease has been steadily increasing and has reached epidemic proportions.

Most physicians receive little or no training in nutritional matters or the treatment of obesity. Perhaps because the treatment of obesity is less glamorous and more frustrating than the treatment of other conditions, too many physicians are unable or unwilling to deliver effective medical assistance to overweight patients struggling to manage their weight. Too often, this void is filled by commercial interests more focused on "the bottom line" rather than on the health of the consumer.

The treatment of obesity has been hindered by myths, misconceptions, and prejudices about its causes and consequences. The obese individual is not simply a lazy, metabolically normal adult with too much adipose tissue; rather, he or she is a metabolically complex individual who may respond differently to nutritional intake and exercise/activity.

The causes of obesity are complex and multifactorial. Its treatment, therefore, must be multimodal and tailored to meet the individual needs of the particular patient. This book will discuss the essential, clinical guidelines, and standards of each treatment option from dietary interventions to bariatric surgery, as well as the bariatrician's role in this treatment option.

Dietary intervention is the mainstay of bariatric treatment. In order to individualize treatment, the physician needs to be familiar with various approaches, including low calorie diets, low-carbohydrate diets, and very low-carbohydrate diets (VLCD). It is our hope that nutritionists and dieticians will benefit from the detail and level of discussion of these dietary interventions in addition to the bariatric physician.

Exercise is an important part of weight loss efforts and is probably essential for long-term weight maintenance. It provides numerous benefits in addition to its effect on weight. While patients are willing to follow almost any diet plan, it is often difficult to get them to initiate and sustain a meaningful exercise regimen.

Weight loss and maintenance require that individuals make changes in the way they interact with their environment. In this effort, they battle with a culture that, on one hand, values being fit and trim and, on the other, promotes obesogenic food patterns and sedentary lifestyles. To succeed, the overweight individual must be armed with effective strategies to deal with internal and external forces that favor the overweight state.

Various pharmaceutical agents have been used to help facilitate weight loss. Anorectic agents have been in use for over four decades and have been shown to be both safe and effective. Newer agents that inhibit the absorption of fat or carbohydrate are also available. Various other pharmaceuticals and some natural substances may also play a role in helping with the process of weight management. On the other hand, there are many common medications that promote weight gain, and replacing these with ones that are similarly effective but less likely to impact weight negatively can often bring rewarding results.

We must also consider, when treating the bariatric patient, that children represent a special population with special needs. The increasing incidence of obesity (and attendant type II diabetes) in this population is alarming. Clearly, something must be done to stem this tide or, as has been suggested, today's generation of children will be the first generation of Americans with a life expectancy less than that of their parents. The chapter on Childhood Obesity clearly identifies the special needs of children and outlines approaches for managing the obese child.

For some individuals, obesity and its comorbidities advance to such a degree that their life is at considerable risk. For them, bariatric surgery may be warranted. It is essential that they be properly evaluated before surgery, skillfully treated during surgery, and followed appropriately afterwards. The bariatric physician plays an important role in treating the patient perioperatively if bariatric surgery is a determined method of treatment for a particular patient.

Those of us who have developed a special interest and specialize in the field of bariatric medicine find great satisfaction in the work we do and the role we play in helping our patients live healthier, happier, and longer lives. We are excited about the potential for better understanding of this complex and fascinating disease and for the development of better weapons to use in its treatment.

To our colleagues engaged in academic and clinical research, we offer our sincere appreciation for your efforts and eagerly await the fruits of your labor.

To our colleagues engaged in clinical practice who are awakening to this field and want to improve their skills and expertise in the medical management of obese patients, we extend our heartfelt encouragement and support.